The third habit of Stephen Covey’s The Seven Habits for Highly Effective People is Put First Things First. The basic premise is that for many there are a lot of things competing for our time and attention. Some are important; some not. Some are urgent; some not. Covey emphasizes that we should prioritize our time to concentrate on the important but not urgent. To achieve this goal requires some reflection and decision-making skills, as well as some trial and error.

In many healthcare settings I think many believe that it would be a luxury to able to actively decide what is important and what is not urgent and focus on these things. There does not seem to be enough time to get the important things done. Many if not most tasks seem urgent. Consider a visit to the primary care physician. The standard seems to be that a patient will get a 15 minute visit. Spending more time would not produce enough income. Even if it is important that a visit be longer, affording the time seems impossible. This is just one example. I am sure that each of you can recount many daily situations where finding time to get the important things done is next to impossible.

Fortunately there is an approach to finding more time to get the important things done, so that the urgent become much less so. The path lies with taking the approach of the Toyota Production System of identifying wasted time and eliminating it. Wasted time in the TPS is one of the seven types of waste. Since most in healthcare are not trained to recognize wasted time or effectively change it when we do recognize it, we end up delivering less effective care than we would like at times. Consider the following examples of wasted time:

A. A surgery scheduled in a hospital is delayed or postponed because a vital piece of information such as a test result does not show up in time. Delays in scheduled surgeries are all too common in some hospitals because the right information such as test results cannot be found or a member of the surgical team is delayed in arriving.

B. There are long waits in the emergency department for most patients except the critical ones. There just does not seem to be adequate staff to meet the volume of service demand. With the increase of patients due to the increasing number of uninsured, the problem seems only to be worsening. These delays affect the bottom line of the hospital as patient throughput drops.

C. Patients at primary care sites have to wait past their scheduled appointments or have to wait for weeks or longer to schedule appointments for noncritical care. The Institute of Medicine identifies timeliness of delivery of care as an important goal for the primary care site in Crossing the Quality Chasm. Not doing so can cause serious problems. For instance, a patient who cannot get an appointment within a day or two of calling may experience a complication of a problem which would otherwise could be treated simply. Having patients endure long waits for scheduled appointments can lead to stress and ill will towards the health team at the site. In any other service market, such as financial products markets, such treatment of customers would not be acceptable. The customer would undoubtedly find a better service provider. Although healthcare patients seem to accept delays as inevitable, physicians are most likely losing patients, losing income because of lower throughput of patients, and experience more difficulty interacting with patients who feel neglected.

These delays and many like them can be overcome. More time can be found to get the important things done. It will take changes in culture and thinking, changes in communication, and learning the use of new tools and approaches to accomplish the changes.

Let me illustrate what can be accomplished and what it takes to achieve them with some examples. In one emergency department there were often long delays in providing service. A lean quality expert studied the activities of the triage nurse. The quality expert in mapping the movements of the nurse with a tool used in Lean production-a spaghetti diagram–found that the nurse was walking approximately 10 miles each shift. At a normal walking pace that is four hours of walking, time not accomplishing the tasks he or she should be doing. With a team of representatives from the ED that time was cut down considerably and patient wait times decreased significantly. Patient throughput increased.

At Virginia Mason Hospital delays in surgery were considerably lessened using the pull system and takt time from the Toyota Production System. The ideas behind the two concepts is that all the necessary tools, personnel, patient and information arrive at the right time for the surgery to begin on time and proceed without delay. The timing of the flow of personnel, patient, instruments and information is carefully measured over many occasions, identifying bottlenecks and waste as measurements are taken. Teams then work to eliminate the waste and unblock the bottlenecks. By eliminating wasted time, eliminating bottlenecks, and coordinating flows, delays are mostly eliminated. To accomplish these changes at Virginia Mason it was necessary to change the culture of the hospital. Leadership had to learn and understand the Toyota Production System and actively support it. Staff needed to learn new ways of working together in teams to identify and eliminate waste and bottlenecks. The changes did not come easily or quickly. Much of the experience of change at Virginia Mason Hospital is described in John Black’s book The Toyota Way to Healthcare Excellence.

Primary care facilities can overcome many of the patient delays with open access scheduling. With open access scheduling, time is left open in patient scheduling so that patients can call in for an appointment and be seen either that same day or the next day. Using open access scheduling not only decreases delays for the patient it also improves patient throughput. The number of no-shows for appointments decreases, thus improving throughput. Implementing open scheduling is not easy. It requires patience, much effort by the staff working as a team, and often a change in focus to become more patient-centered.

As Stephen Covey points out, it is very necessary to focus on how we spend our time so that we can be highly effective. Time seems to be a precious commodity at most healthcare sites and always in short supply. Using approaches and tools to identify and eliminate wasted time-a hallmark of the Toyota Production System-can dramatically improve patient outcomes and financial outcomes. To achieve these goals requires a new ways of working together and active involvement by leadership in guiding the necessary changes. The task is not easy.

Plastic surgery in Mexico is getting a bit more organized. Due to the demand for lower plastic surgery cost and consumers still demanding savings for medical care, affordable plastic surgery in Mexico is again on the hype.

Two weeks ago, Grupo Angeles, the parent company of Mexico’s largest private hospital group, Hospital Angeles, signed a contract with Health Travel Guides (HTG) to provide the technology infrastructure for managing its medical tourism operations. Another leading medical tourism agency, GoSculptura, now provides excellent but affordable plastic surgery packages in Mexico. GoSculptura now includes Mexico in its network of medical vacation destination and now has more than 500 satisfied patients and a 97% satisfaction rate. Other agencies such as Healthbase also chose the country to be part of its health care network and provide U.S. patients satisfactory plastic surgery in Mexico.

The overwhelming plastic surgery cost and the long wait to get medical treatment are two of the top reasons why American patients travel to other countries to receive medical and dental work. Whether a good new hip and a nice new face, you might have to dig deep into your wallet or wait several months before receiving the medical or dental care that you require. In 2006, more than 50,000 Americans go abroad to acquire affordable plastic surgery and dental work. According to the National Coalition on Health Care, year by year millions of patients from all places go to Mexico, Argentina, India, Dominican Republic, Brazil and Costa Rica. The reason – to evade the trauma of plastic surgery cost, to acquire affordable plastic surgery with less time to wait and experience inclusive vacation package and recuperation activities. These countries are top notch medical destination places where health care, medical facilities and surgeons are comparable and may exceed the quality of health care of the U.S.

As of now plastic surgery in Mexico is at the height of fame, thanks to medical tourism agencies. Mexico offers the same medical care quality as the U.S. but goes out with rock-bottom plastic surgery cost. Although the medical care in Mexico may not be as inexpensive as the ones in some Asian nations, the proximity to the U.S. is a big advantage to patients. Some U.S. companies are now sending employees to Mexico for their annual checkups. Some expert also find Mexico as a definite answer to treat the aging and under-insured Americans at a time when the retirement of baby boomers will further tax the U.S. health care system. An estimated 43 million Americans, about 15 percent of the population, are uninsured, according to a Census Bureau study.

The growth of medical tourism in Mexico and how the country will mature in terms of health care will determine the future of most American patients. According to Peter Maddox, Christus Health senior vice president for business, strategy and corporate development, “Our country will go broke unless we find a health care alternative”. He sees Mexico as a wonderful alternative with incredible potential.

As pet owners, we all want to improve the health and well-being of our family dog. Dog health care makes both animals and owners more pleased. It can certainly be a little difficult understanding problem dog health signs and symptoms, however it’s also fun and helpful to you and also your own family dog. Healthy and balanced dogs are usually content dogs and makes for a wonderful companions!

Understanding about various types of signs and symptoms, as well as just how to take care of your own family pet in a normal and also nurturing method will give you a much better lifestyle for your friend. As you handle your dog and make its health better, a closer connection is formed. We now have a few tips to assist you with dog illness diagnosis and also to give a more natural health for any dog which will totally strengthen your friendship with your furry friend.

1) Oral health and nutrition is of the utmost of importance to your dog’s overall health. If a pet dog doesn’t have strong teeth, then it can’t eat properly. For nutrition, one can consult a dog breed guide, as differing breeds have different food needs. For the teeth, there’s regular old cleaning or perhaps dental food products that can help.

2) What food you provide (or don’t provide) your pet, both people and dog food will go quite a ways in the direction of ailment avoidance. Fresh fruit similar to grapes is just not good for the dog. Another rule is that most vegetables are great for your pup. Look for additional info from your local veterinarian in case you are unclear. Dogs are usually omnivorous along with a blend of vegetables and necessary protein is wonderful for them – simply check to be sure which ones.

3) Do not provide the dog chocolate. It’s not really good dog care to begin with, but chocolate contains Theobromine. Keep on hand a few wholesome alternative snacks that they can enjoy. You can even find unique bakeries for most dogs today.

4) Arthritis can be quite a discomfort in the important joints for both pet dogs and humans. Needless to say, medications and therapy are very different with animals and humans. A veterinarian will make good quality suggestions if the medical diagnosis suggests arthritis. You will find nutritional vitamins, supplements, prescription drugs, as well as special pet food which supports your dog’s arthritis.

5) Physical exercise. This can be a easy and free of charge method to boost the health and fitness of your pet. If your dog is actually obese it can lead to most of the identical pathologies humans may build up. Exercising your pet is a symbiotic relationship as you’ve got to do a similar thing your dog is performing (for example walking or even jogging) so that you may also experience the benefit!

Take your pet to regular veterinary appointments, take care of him or her your self on a daily basis, and ensure that you workout – both of you, that is! Continue to keep a journal for your own dog and this may really help the vet if a thing critical arises.

AEDs (Automated External Defibrillators) are installed in schools, malls, shopping centers, theaters, offices, health clubs, government buildings, factories, airports, etc. to provide first aid to the victims of sudden cardiac arrest. The victim is given a biphasic defibrillation shock with the AED which helps to bring back the heart beat to normal. As the AED equipment is used in case of emergency where it is a matter of life and death the accuracy rate of the equipment plays a major role. It is advisable to use equipment that complies with standards of organizations like Association for the Advancement of Medical Instrumentation (AAMI) and the American Heart Association’s (AHA).

AED Maintenance

Apart from using the good quality AED equipment, it is very important to take care of it to ensure its reliability during need. Regular maintenance of the AED is very essential for the proper functioning of the equipment. The AED equipment must be timely tested in accordance with guidelines formulated by the manufacturer and the American Red Cross and American Heart Association. The maintenance and testing should be in compliance with rules and regulations set by US Food and Drug Administration. A check list should be maintained and a strategic maintenance program should be implemented in every organization where the AED is installed. This will help to keep the AED in ready-to-use condition and save many precious lives in case of emergency.

o The AED analyzes the rhythm automatically and the voice prompt informs the rescuer not to touch the patient during the process. If a shock is required, the voice prompt will inform the responder of it. The voice prompts guide the responder through the process of defibrillation and CPR and re-analyze the rhythm to determine whether defibrillation is needed or not.

o If the patient gains consciousness after defibrillation and CPR, make the patient comfortable until the EMS personnel arrive. Apart from this, the responder should know how to maintain the AED device properly so that it’s ready for use in case of emergency.

o It is important that the victim gets CPR until the EMS personnel reach the spot. Most people are not aware of the fact that not all the victims of sudden cardiac arrest require defibrillation. Around half of the victims can be revived by CPR which involves chest compressions. Cardiopulmonary resuscitation or CPR is essential to help in flow of oxygenated blood to brain and other vital organs. It is important to learn CPR techniques and using an AED as most sudden cardiac victims die because bystanders are unaware of what they should do to help the victim.

You can save the victims of sudden cardiac arrest in your home, workplace or community by learning to use automated external defibrillator and delivering CPR. By performing AED emergency response drills, you can save a precious life in an emergency medical situation.

We have previously discussed the research needed to create a marketing strategy that identifies a target demographic. The purpose of this research is to allow us to compare our relative strengths and weaknesses verses our direct competitors strength and weaknesses within the marketplace. Once our relative position in the competitive marketplace has been researched, a strategy that pits our strength against our competitor’s weaknesses can be formulated. This process is called marketing strategy.

Part of the marketing strategy is to formulate headlines and ad copy based on our relative position in the marketplace. We want our marketing to highlight our relative strengths against the relative weakness of our direct competition. All of this positioning must be crafted within the context of the solution to a specific problem that exists in a coveted demographic within our marketplace. The ultimate goal is to create a perception within the collective minds of our demographic that we have the best answer to solve their specific problem. This well researched, well crafted message is our marketing warhead.

The more congruent our message is with the wants and desires of our coveted market demographic, the bigger bang we will receive from our marketing efforts. This “bang” is measured as our response rate. This process of marketing strategy sends us into battle (contention for potential patients) under advantageous conditions. The process we have just described is the definition of marketing strategy. The better the marketing strategy, more effective the headline and ad copy. Notice that we stated the better the strategy the more effective the headline and copy will be. We didn’t say the more effective the marketing campaign will be. This is because there is one more major consideration that helps to determine how effective or ineffective a marketing campaign will be. The other piece of the puzzle is your delivery systems.

If the strategy and the headlines and ad copy are the warhead of your marketing campaigns, the next step in successful marketing is the missile or delivery system.

The variables for marketing success are the quality of your research, the art and science of your strategy development, the alignment of your headline and ad copy with your marketing strategy and finally the efficiency and cost effectiveness of your delivery systems.

You can have a nuclear warhead when it comes to knowledgeable strategy, headline and ad copy, but will obtain mediocre results if you choose a weak delivery system. Conversely you may have the best most effective delivery system and obtain marginal marketing results if your strategy, headline and copy are weak.

Optimizing all three components and constantly testing and perfecting these aspects of your marketing campaign is the key to effective, efficient and profitable marketing that produces a handsome return on investment.

We have discussed the intricacies of developing marketing strategy in another paper. The marketing metrics required to evaluate the return on investment (which is another way to say the marketing efficiency) has been discussed in a previous paper. This paper will integrate marketing strategy and research with marketing metrics to create a framework with which to evaluate marketing delivery systems. This process is a real world method for first determining and then improving both marketing effectiveness and marketing efficiency.

Before we can evaluate our marketing effectiveness and efficiency we must first define marketing effectiveness and efficacy.

Marketing effectiveness is how well a campaign or the action steps within a campaign’s execution produce a favorable response. What is a favorable response and how do we know if we got one? Well despite what marketing aficionados might tell you, marketing execution can be measured. There are several tangible measurements that matter and they are new (or repeat) business depending on your strategy, revenue increase and profit

Your marketing strategy can be judged to be effective if 1. It produces new business, 2. It increases revenues and 3. It increases profit.

It has nothing to do with image, branding, awareness or intangible returns.

In the context of marketing a professional practice, new business would be “kept” new patient appointments. Revenue is the gross collections increase from previous months and profits means your return on investments, also expresses as increased revenue minus the cost of your marketing effort.

By themselves these measures can give you a good handle on the effectiveness or not of your marketing execution. The next step is to eliminate marketing action steps that are not effective and to optimize those marketing activities that are proven to be effective. Once marketing effectiveness and marketing efficiency are optimized you merely repeat the most effective and efficient action steps. Again and again.

This process is impossible without marketing metrics and return on investment measurement. In fact according to the Harvard Business School no marketing action plan is complete without steps to measure and evaluate the implementation of a campaign. (1)

(1) Harvard Business Essentials

Marketer’s Toolkit

Harvard Business School Press 2006

Let’s look at an example at how all this works. Let’s compare giveaway coffee mugs with a full color print on demand booklet. Online print on demand printers can produce a 6.5 x 9 inch full color saddle stitch booklet at a cost of $6.50 per unit. Let’s compare this against a custom imprinted coffee mug, available for an average cost for mugs of about $1.50

At first glance the mugs seem like a much better marketing investment.

But are they? Let’s say our coveted marketing demographic is women ages 35 to 55 and we have found through are research that this market segment has a health problem: menopause or perimenopause.

First let’s look at headline opportunities.

With the coffee mug you are severely limited by space. You’ll need to try to create a slick trendy and catchy headline. Something like:

“Got Hormones?”

There is not much room on a mug to do much else. What are our options with the print on demand booklet? With the booklet, space constraints are not an issue.

Here are several options:

– “A doctor’s guide to choosing the best treatment options for your perimenopausal symptoms”
– “Tired all the time, irritable, depressed, gaining weight? These are symptoms of perimenopause” “Learn about modern treatment options.”
– “What every women should know about perimenopause and how she can feel good again.”

Really with the space the booklet provides the headline can be extremely specific. You can use subtitles and even an excerpt from the content on the cover. So in terms of our warhead, which one do you think produces a bigger bang?

“Got Hormones?” or “Tired all the time, irritable, depressed, gaining weight? These are symptoms of pre menopause” “Learn about modern treatment options.”

With the coffee cup the story ends here. Because of space restrictions you can’t really get much more detailed. You might put your name on the mug, but you would be hard pressed to add much more information. The catchy headline “Got Hormones?” hopefully will start conversations about you and your services. The downside of this is obvious however. If you give your coffee cups to a patient or the owner of a trendy salon and if one of her customers sees the mug and asks the proprietor about hormone replacement, what are the odds that layperson can represent you and your services in a dramatic, appealing and informative way? Patients rarely remember to take their medications yet alone the reasons why they should and all available options you discussed with them.

In other words, the coffee cup doesn’t allow you to give enough information to sell your service to a prospect. It relies on third party information. The coffee cup hits a dead end rather quickly.

So in terms of a marketing warhead the coffee cup is more fizzle than bang. There is simply not enough space on the cup to allow you to create a headline that is in alignment with your target markets’ problem, yet alone enough space to educate her on how you have the solution to that problem. In other words, there is no way, using a coffee cup, to position you and your service in the mind of a prospective patient. Unless of course you sell coffee.

In terms of effectiveness, the coffee cup while seemingly relatively inexpensive is of dubious effectiveness. It doesn’t matter how cheep the mugs are, if they are not effective they are expensive.

Let’s go back to our full color booklet.

It’s full color so you can use appealing photos and graphics. There is plenty of room on the cover to place a well thought out headline that will stimulate your target to read the copy. Then there is the copy. With 15 pages you have plenty of time and space to sell yourself as the answer to your prospect’s problem.

You should always include a section that details your education and experience. This has been termed your unique selling proposition (USP) or your exceptional value statement (EVS). It is your chance to toot your own horn and you should toot it loudly. The purpose of the EVS is to position you in the prospect’s mind as the “go to” doctor. Your EVS must be powerful enough to motivate the prospective patient to drive by hundreds of other doctors on the way to your office. So spend some time on it and if you don’t feel comfortable talking about yourself, have someone read your CV and write your exceptional value statement for you.

Next let’s consider the body of your ad copy. This is where your research and marketing strategy comes into play. In your booklet you are going to list the basic approach of all your competitors. This may seem counter intuitive but remember you will be highlighting their weaknesses as you go. You are going to offer up alternatives to your own treatment approach, but frame them in a way that showcases their (your direct competitor’s) specific weaknesses. You slowly introduce your answer to the prospect’s problems. If your copy writer is talented, he or she should be able to bring the prospect along so by the end of your information booklet, the only logical conclusion for the reader is that you have the best answer to their problem. Never bash your competition, only frame your comparison highlighting the strengths of your approach compared with the relative weaknesses of your competition.

This shouldn’t be too difficult if you have developed marketing strategy as we discussed in previous papers.

Now within the booklet you should always include multiple ways for your readers to respond. Of course your office address and phone number, but also your web address and email. Perhaps an invitation to take an on line survey and of course your innovative Ask-the-Doctor program. How about a detachable postcard?

All of these methods of response should be interspersed throughout the text of your booklet. Not hidden at the very end.

The most important thing to remember is that your booklet should include valuable information. Don’t worry that you might be giving something away for free. If your information helps the patient they will consider you an expert. They will consult with you when they need help. They will already know that you can help them, because you already have.

Consumers are deluged with advertising offers. Research shows they are more likely to read marketing material if it contains valuable information that will likely benefit them. If your booklet is valuable it will have staying power. It may also be copied and passed around. It might be a good time to mention that you should waive the copyright and tell the reader to feel free to make copies and pass the booklet around.

So after reading this article do you still think that coffee mugs are an effective way to market? Are they efficient? They may cost less than a full color booklet, but do you think they are more cost effective?

If a marketing action step produces no return on investment, is it a good a deal at $100.00, $50.00, $5.00? Do you want to repeat it again and again? Conversely if you spend $2000.00 on action steps than returns $10,000.00 to your practice, is it expensive?

You can’t tell which actions steps are smart, effective and efficient marketing unless and until you measure.

This article provides a brief glimpse at the metrics and thinking behind the marketing metrics that will help your choose effective and efficient methods of marketing your professional practice. Refer to my other articles on marketing strategy and marketing metrics.